Background & Aims
Linezolid, a Group A drug recommended by WHO for MDR Tuberculosis. Neuropathy is common with Linezolid treatment for more than 4 weeks. Till now few cases of severe sensory motor neuropathy associated with Linezolid have been reported. Here we are going to discuss five patients in which prolonged use of Linezolid to treat MDR TB was followed by development of acute sensory motor peripheral neuropathy and lower limb motor dysfunction, which was not responsive to oral medication and improved after Lumbar Sympathetic Block.
These patients (5) presented with complaints of Burning pain, allodynia, tingling and numbness of foot. To assess power in lower limb, we elicit history of slipping of chappals and assess great toe grip. It showed reduced power in all our patients. We first put all patients on neuropathic oral medication but at some point in time, oral medications stopped working. We then decided to treat them with Lumbar Sympathetic Block with local anaesthetic agent and steroid
Methods
We had five patients of MDR TB treated with Tab Linezolid, showing peripheral neuropathy with motor dysfunction as its side effect. Assessment of pain was done by Pain Detect Score (PDS). The sensory descriptors are a scored on a scale of 0 (NIL) to 5 (very strong) and radiating pain as 1 (Yes) or 0 (No). Score of ? 19 indicates neuropathic pain Likely and ? 12 neuropathic pain Unlikely. All our patients had score between 18 to 26. As PDS does not cover motor response, we assessed great toe power of lower limb which was 4/5.
We treated these patients with Fluoroscopy Guided Lumbar Sympathetic Block. Drugs used were Inj. Ropivacaine 0.5%, Inj. Triamcinolone 20 mg and Normal Saline.
Confirmation of Block was done with the spread of Non Ionic Contrast in continuous AP view of C-Arm as longitudinal spread, hugging the lateral vertebral body.
Post procedure patients presented with improved Pain Detect Score and improved great toe motor power.
Results
All five (5) patients were doing good till now, except one patient (Patient 5), whose pain reoccurred after 25 days. We proceeded with cooled radio-frequency ablation of lumbar sympathetic nerves and the patient is doing well now with complete pain relief.
Conclusions
Thus, we are providing the clinical evidence that sympathetic nervous system has an evident role in Linezolid induced sensory motor peripheral neuropathy and Lumbar Sympathetic Block can be an effective treatment modality in case of Linezolid induced peripheral neuropathy with motor dysfunction.
References
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Presenting Author
Manjiri Ranade
Poster Authors
Manjiri Ranade
MBBS, DA, FIAPM, FISSP
Palash Pain & Palliative Care & Jupiter Hospitals
Lead Author
Topics
- Specific Pain Conditions/Pain in Specific Populations: Neuropathic Pain - Peripheral